HRACI Membership Renewal

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IndySHRM Membership Renewal

Renew your membership online by filling out the secure form below.

By renewing today your membership will expire on 12/31/2010

Cost for renewal is:
Renewal - $90
Student Renewal - $45

IndySHRM Membership Renewal Form
Name
Certification (PHR, SPHR, GPHR)
Position
Company
Address
City
State
Zip
Phone
Fax
Work (or school) E-Mail
Do you or your company pay for your membership?	I pay My employer pays
Personal Information (Home address, phone and e-mail will not be published.)
Home Address
City
State
Zip
Phone
Permanent/Home E-Mail
Are you a member of SHRM?
If yes, what is your SHRM membership number?
Demographic Information All information is for IndySHRM internal use only.	What is your gender? Male Female What is your ethnicity? Multicultural Native American/Alaskan Native Asian/Pacific-Islander Black Hispanic White other: What is your geographic location(s) of preference for meetings? North Northwest Northeast Downtown West East South Southwest Southeast Job Function HR Generalist Employment/Recruitment Benefits Compensation Labor/Industrial Relations Training/Development Organizational Development Legal Health, Safety, Security Empoyee Asst. Programs Employee Relations Communications EEO/Affirmative Action HRIS Research Consultant Administrative International HRM Diversity other: Secondary Job Function HR Generalist Employment/Recruitment Benefits Compensation Labor/Industrial Relations Training/Development Organizational Development Legal Health, Safety, Security Empoyee Asst. Programs Employee Relations Communications EEO/Affirmative Action HRIS Research Consultant Administrative International HRM Diversity other: Business Industry Agriculture, Forestry, Fishing Manufacturing (nondurabe goods) Manufacturing (durable goods) Transportation Utilities Wholesale/Retail Trade Finance Insurance Services (profit) Services (nonprofit) Health Real Estate Educational Services Government Construction/Mining Oil & Gas Library Publishing/Broadcast Independent Consultant High Tech other: Company size: fewer than 100 100-499 500-999 1000-2499 2500-4999 5000-9999 10000-24999 25000 and more Membership type: Professional Vendor Consultant Student Number of experience in HR - whole years only
Membership Type	Renewal - $90 Student Renewal - $45
	I would also like to join the IndySHRM SIG: SMA Central Indiana(no extra cost to join) click here for more information on SMA-Central Indiana I would also like to join the IndySHRM Consultants Forum Special Interest Group. click here for more information on the Consutlatns Forum
Payment Method	Please charge my Visa or MasterCard American Express Mailing Check (Make check payable to: IndySHRM, 8945 South Street, Fishers, IN 46038)
Credit Card #
Expiration Date
Name on Card
Amount
Any specific comments/requests?
Print this form then Click the submit button Please wait until you get a confirmation screen.

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Human Resource Association of Central Indiana
Affiliate of the Society for Human Resource Management
9840 Westpoint Drive, Suite 260
Indianapolis IN 46256
Phone: (317) 841-3236 Fax: (317) 841-8206
e-mail: information@hraci.org